Advance health directives : competing perceptions, intentions and use by patients and doctors in Queensland

This paper reports on mixed method empirical research undertaken with individuals who have completed advance health directives (‘principals’) and doctors who have either attested to the principal’s capacity when the document was completed or been called upon to use these documents in clinical settings. Principals and doctors appear to have different understandings of the purpose of these documents and their role in decision-making about medical treatment. We recommend changes to the advance health directive form in Queensland to promote informed decision-making which will help to better align perceptions of principals and doctors about the role of these documents.

Assessment of damages for wrongful birth and consolidation in advance care directives

The recent decision of Waller v James involved a claim by the plaintiff parents for damages for wrongful birth against the defendant doctor, Dr James, a gynaecologist with a practice in infertility and IVF procedures, who had been consulted by the plaintiffs. The second plaintiff, Mr Waller suffered an inherited anti-thrombin deficiency (ATD), a condition which results in a propensity for the blood to clot, at least in adults. Dr James subsequently recommended IVF treatment. The first plaintiff, Mrs Waller became pregnant after the first cycle of IVF treatment. Her son Keeden was born on 10 August 2000 with a genetic anti-thrombin deficiency. Keeden was released from hospital on 14 August 2000. However, he was brought back to the hospital the next day with cerebral thrombosis (CSVT). As a result of the thrombosis, he suffered permanent brain damage, cerebral palsy and related disabilities. The plaintiffs alleged that the defendant was in breach of contract and his common law duty of care to the plaintiffs in failing to inform them, or cause them to be informed, of the hereditary aspects of ATD. They further alleged that, had they been properly informed, they would not have proceeded to conceive a child using the male plaintiff’s sperm and therefore avoided the harm that had befallen them. The plaintiffs claimed damages to compensate them for their losses, including psychiatric and physical injuries and the costs of having, raising and caring for Keeden. The defendant was held to be not liable in negligence by Justice Hislop of the Supreme Court of New South Wales because a finding was made on medical causation which was adverse to the plaintiffs claim.

Can tissue engineering concepts advance tumor biology research?

Advances in tissue engineering have traditionally led to the design of scaffold- or matrix-based culture systems that better reflect the biological, physical and biochemical environment of the natural extracellular matrix. Although their clinical applications in regenerative medicine tend to receive most of the attention, it is obvious that other areas of biomedical research could be well served by the powerful tools that have already been developed in tissue engineering. In this article, we review the recent literature to demonstrate how tissue engineering platforms can enhance in vitro and in vivo models of tumorigenesis and thus hold great promise to contribute to future cancer research.

Advance Australia Fair : social democratic and conservative politicians’ discourses concerning Aboriginal and Torres Strait Islander Peoples and their health 1972–2001

This paper reports research undertaken as part of a larger project in which we examined whether and how values and beliefs communicated by Australian politicians have shaped decades of health policy and influenced health outcomes for Aboriginal and Torres Strait Islander Peoples of Australia. To first characterise those values and beliefs we analysed the public statements of the politicians responsible nationally for the health of Aboriginal and Torres Strait Islander Peoples 1972–2001, using critical discourse analysis. We found that four discourses, communicated through words, phrases, sentences and grammatical structures, dominated public statements over the study period. These four discourses focused on the competence and capacity of Aboriginal and Torres Strait Islander Peoples to “manage”; matters of control of and responsibility for the health of Aboriginal and Torres Strait Islander Peoples; Aboriginal and Torres Strait Islander Peoples as “Other”; and the nature of the “problem” concerning the health of Aboriginal and Torres Strait Islander Peoples. Analysis of the discursive elements contributing to shaping these four discourses is reported in this paper.

Availability of advance visual information constrains association-football goalkeeping performance during penalty kicks

A pressing concern within the literature on anticipatory perceptual-motor behaviour is the lack of clarity on the applicability of data, observed under video-simulation task constraints, to actual performance in which actions are coupled to perception, as captured during in-situ experimental conditions. We developed an in-situ experimental paradigm which manipulated the duration of anticipatory visual information from a penalty taker’s actions to examine experienced goalkeepers’ vulnerability to deception for the penalty kick in association football. Irrespective of the penalty taker’s kick strategy, goalkeepers initiated movement responses earlier across consecutively earlier presentation points. Overall goalkeeping performance was better in non-deception trials than in deception conditions. In deception trials, the kinematic information presented up until the penalty taker initiated his/her kicking action had a negative effect on goalkeepers’ performance. It is concluded that goalkeepers are likely to benefit from not anticipating a penalty taker’s performance outcome based on information from the run-up, in preference to later information that emerges just before the initiation of the penalty taker’s kicking action.

Leveraging R&D to advance digital modelling practice in Australian construction

This paper describes a lead project currently underway through Australia’s Sustainable Built Environment National Research Centre, evaluating impacts, diffusion mechanisms and uptake of R&D in the Australian building and construction industry. Building on a retrospective analysis of R&D trends and industry outcomes, a future-focused industry roadmap will be developed to inform R&D policies more attuned to future industry needs to improve investment effectiveness. In particular, this research will evaluate national R&D efforts to develop, test and implement advanced digital modelling technologies into the design/construction/asset management cycle. This research will build new understandings and knowledge relevant to R&D funding strategies, research team formation and management (with involvement from public and private sectors, and research and knowledge institutions), dissemination of outcomes and uptake. This is critical due to the disaggregated nature of the industry, intense competition, limited R&D investment; and new challenges (e.g. digital modelling, integrated project delivery, and the demand for packaged services). The evaluation of leading Australian and international efforts to integrate advanced digital modelling technologies into the design/construction/asset management cycle will be undertaken as one of three case studies. Employing the recently released Australian Guidelines for Digital Modelling developed with buildingSMART (International Alliance for Interoperability) and the Australian Institute of Architects, technical and business benefits across the supply chain will be highlighted as drivers for more integrated R&D efforts.

Analysing mentoring practices to understand how a preservice teacher reflects on practice to advance teaching

Mentors (cooperating classroom teachers) have a shared responsibility with universities for developing preservice teachers’ pedagogical practices, particularly towards becoming reflective practitioners. Preservice teachers need to participate actively in their own learning, by reflecting and acting on the mentor’s constructive feedback provided during planning and feedback dialogue sessions. This case study uses feedback practices outlined within a five-factor mentoring model to analyse dialogue between a mentor and her respective mentee during different stages in their school-based programs (first practicum). This investigation uses multiple data sources such as video and audio-recorded interviews, archival documents from participants such as lesson plans, reflections and reports to examine preservice teacher’s reflections and implementations of practice as a result of her mentor’s feedback (e.g., establish expectations, review lesson plans, observe teaching then provide oral and written feedback, and evaluate progress). Findings indicated that reflective thinking was more apparent when the mentor did not dominate conversations but instead asked astute pedagogical knowledge questions to facilitate the mentee’s reflections on practice.

The taxing effects of the advance pricing arrangement program: A review of APAs and their impact on stakeholders

The current transfer pricing rules contained in Australia’s taxation regime are designed to counter the underpayment of tax by businesses engaged in international related-party dealings. Currently, these transactions must take place at an arm’s length price, a requirement which is becoming increasingly difficult to demonstrate. This results in an increased risk of an audit by the Australian Taxation Office. If a taxpayer wishes to avoid the risk of an audit, and any ensuing penalties, there is one option: an advance pricing arrangement (‘APA’). An APA is an agreement whereby the future transfer pricing methodology to be used to determine the arm’s length price is agreed to by the taxpayer and the relevant tax authority or authorities. This article investigates the use of APAs as a solution to the problem of transfer pricing and considers their impact on stakeholders. It is argued that while APAs provide a valuable practical tool for multinational entities facing the challenges of the taxation of global trading under the current regime, they may not be a practical long term solution.

Advance pricing arrangements : an Australian Tax Office success or a legislative failure?

Australia’s domestic income tax legislation and double tax agreements contain transfer pricing rules which are designed to counter the underpayment of tax by businesses engaged in international dealings between related parties. The current legislation and agreements require that related party transactions take place at a value which reflects an arm’s length price, that is, a price which would be charged between unrelated parties. For a host of reasons, it is increasingly difficult for multinational entities to demonstrate that they are transferring goods and services at a price which is reflective of the behaviour of independent parties, thereby making it difficult to demonstrate compliance with the relevant legislation. Further, where an Australian business undertakes cross-border related party transactions there is the risk of an audit by the Australian Tax Office (ATO). If a business wishes to avoid the risk of an audit, and any ensuing penalties, there is one option: an advance pricing arrangement (APA). An APA is an agreement whereby the future transfer pricing methodology to be used to determine the arm’s length price is agreed to by the taxpayer and the relevant tax authority or authorities. The ATO views the APA process as an important part of its international tax strategy and believes that there are complementary benefits provided to both the taxpayer and the ATO. The ATO promotes the APA process on the basis of creating greater certainty for all parties while reducing compliance costs and the risk of audit and penalty. While the ATO regards the APA system as a success, it may be argued that the implementation of such a system is simply a practical solution to an ongoing problem of an inherent failure in both the legislation and ATO interpretation and application of this legislation to provide certainty to the taxpayer. This paper investigates the use of APAs as a solution to the problem of transfer pricing and considers whether they are the success the ATO claims. It is argued that there is no doubt that APAs provide a valuable practical tool for multinational entities facing the challenges of the taxation of global trading under the current transfer pricing regime. It does not, however, provide a long term solution. Rather, the long term solution may be in the form of legislative amendment.

(Neo)Liberal doses of inequality : advance Australia where?

The relationship between social background and achievement has preoccupied educational researchers since the mid-20th century with major studies in the area reaching prominence in the late 60s. Despite five decades of research and innovation since, recent studies using OECD data have shown that the relationship is strengthening rather than weakening. In this paper, the systematic destabilisation of public education in Australia is examined as a philosophical problem stemming from a fundamental shift in political orientation, where “choice” and “aspiration” work to promote and disguise survivalism. The problem for education however extends far deeper than the inequity in Federal government funding. Whilst this is a major problem, critical scrutiny must also focus on what states can do to turn back aspects of their own education policy that work to exacerbate and entrench social disadvantage.

Competency and capacity : the legal and medical interface

Balancing the competing interests of autonomy and protection of individuals is an escalating challenge confronting an ageing Australian society. Legal and medical professionals are increasingly being asked to determine whether individuals are legally competent/capable to make their own testamentary and substitute decision-making, that is financial and/or personal/health care, decisions. No consistent and transparent competency/capacity assessment paradigm currently exists in Australia. Consequently, assessments are currently being undertaken on an ad hoc basis which is concerning as Australia’s population ages and issues of competency/capacity increase. The absence of nationally accepted competency/capacity assessment guidelines and supporting principles results in legal and medical professionals involved with competency/capacity assessment implementing individual processes tailored to their own abilities. Legal and medical approaches differ both between and within the professions. The terminology used also varies. The legal practitioner is concerned with whether the individual has the legal ability to make the decision. A medical practitioner assesses fluctuations in physical and mental abilities. The problem is that the terms competency and capacity are used interchangeably resulting in confusion about what is actually being assessed. The terminological and methodological differences subsequently create miscommunication and misunderstanding between the professions. Consequently, it is not necessarily a simple solution for a legal professional to seek the opinion of a medical practitioner when assessing testamentary and/or substitute decision-making competency/capacity. This research investigates the effects of the current inadequate testamentary and substitute decision-making assessment paradigm and whether there is a more satisfactory approach. This exploration is undertaken within a framework of therapeutic jurisprudence which promotes principles fundamentally important in this context. Empirical research has been undertaken to first, explore the effects of the current process with practising legal and medical professionals; and second, to determine whether miscommunication and misunderstanding actually exist between the professions such that it gives rise to a tense relationship which is not conducive to satisfactory competency/capacity assessments. The necessity of reviewing the adequacy of the existing competency/capacity assessment methodology in the testamentary and substitute decision-making domain will be demonstrated and recommendations for the development of a suitable process made.

Advance transit oriented development typology : case study in Brisbane, Australia

Internationally, transit oriented development (TOD) is characterised by moderate to high density development with diverse land use patterns and well connected street networks centred around high frequency transit stops (bus and rail). Although different TOD typologies have been developed in different contexts, they are based on subjective evaluation criteria derived from the context in which they are built and typically lack a validation measure. Arguably there exist sets of TOD characteristics that perform better in certain contexts, and being able to optimise TOD effectiveness would facilitate planning and supporting policy development. This research utilises data from census collection districts (CCDs) in Brisbane with different sets of TOD attributes measured across six objectively quantified built environmental indicators: net employment density, net residential density, land use diversity, intersection density, cul-de-sac density, and public transport accessibility. Using these measures, a Two Step Cluster Analysis was conducted to identify natural groupings of the CCDs with similar profiles, resulting in four unique TOD clusters: (a) residential TODs, (b) activity centre TODs, (c) potential TODs, and; (d) TOD non-suitability. The typologies are validated by estimating a multinomial logistic regression model in order to understand the mode choice behaviour of 10,013 individuals living in these areas. Results indicate that in comparison to people living in areas classified as residential TODs, people who reside in non-TOD clusters were significantly less likely to use public transport (PT) (1.4 times), and active transport (4 times) compared to the car. People living in areas classified as potential TODs were 1.3 times less likely to use PT, and 2.5 times less likely to use active transport compared to using the car. Only a little difference in mode choice behaviour was evident between people living in areas classified as residential TODs and activity centre TODs. The results suggest that: (a) two types of TODs may be suitable for classification and effect mode choice in Brisbane; (b) TOD typology should be developed based on their TOD profile and performance matrices; (c) both bus stop and train station based TODs are suitable for development in Brisbane.

Why Australian and Indian researchers should collaborate to advance wound management innovation

In 2011, 366 million people suffered from diabetes worldwide, resulting in 4.6 million deaths at a cost of US$465 billion in direct healthcare expenditures1. India has the world’s second largest diabetic population at 61.8 million (8.3% of total population)1, while in Australia 8.1% of the population have been diagnosed with diabetes1. Diabetic foot ulcers (DFUs) affect up to 25% of diabetic patients, precipitating 85% of all diabetic amputations2,3. DFUs have significant social and economic impacts associated with increased hospitalisation rates, cost of care, and the reduced capacity of patients and carers to work. In isolated regions of Australia and India the incidence of DFU and associated infection is substantially increased, resulting in hospitalisation rates up to 4- fold that of major cities...